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Today I realized that I only have one of each day of the week left to spend here. It has certainly gone by quickly. Each site has its own rhythm and I have learnt to have a different set of expectations based on the day of the week.  From the relatively steady pace of Mondays, one moves immediately to the barely controlled chaos of Tuesday vaccination day at Port Maria. Then Wednesday mornings come with their share of “thinking time” where we are afforded the luxury of engaging in academic speak and differential diagnoses.  Alternating Thursdays could be a seemingly unending line of newborns or a steady pace of old timers – ex premies, patients with asthma, sickle cell, epilepsy, the works. Depending on whether or not the charts are available for those chronic patients, you may have an easy time figuring out why they are there or be dependent on a mother (or random accompanying adult) who may very well give you a blank stare when asked why the child is there. Friday is never a bad day, because it means familiar places and faces, and only then am I truly home in every sense of the word. I have become quite accustomed to the undulating rhythm of my weeks here. But this week will be different.  It will be a week of good byes. A week of saying thanks to the many wonderful people at each site that I have met and come to know.  My first goodbye will be to the blog as I look forward to savoring my last few days in my sweet island home. I must begin to pick up the ends of my New York life that have been flapping merrily in the Caribbean sea breeze for the last 3 weeks. I must slowly begin to return to reality. Its been real, Jamaica. You never, ever, ever disappoint. Bless up. Much love. RH

In Port Antonio again today.  Overall my experience at this site has been much less busy than at Annotto Bay or Port Maria. It is a 2 hour drive from the resort so usually by the time we arrive it is around 10am, and ward rounds are generally over. I find that we don’t get many patients (max 1 or 2 each week) by the referral appointment system here so I end up spending most of my day in the A&E, which is still quite enjoyable.  And Port Antonio always signals the beginning of weekends with family, so really no complaints whatsoever. One thing struck me today, which I hadn’t taken much notice of in the past 3 weeks.  In my entire time here I don’t think I have used standard English in more than a handful of my conversations with patients. Occasionally I find myself starting off in English and then subconsciously lapsing into Patois, when I truly need to make myself understood.  The same goes for my interaction with almost all of the Jamaican staff too – nurses, other doctors, drivers, people at the resort, everyone.  Its quite refreshing and relaxing for me, but I am curious as to what it is like for non-Jamaicans who volunteer. Communication of basic concepts in English would certainly not be a problem, but I wonder how many of the nuances and subtleties of patients’ stories get lost in translation. It makes me wonder what gets said and understood and even more importantly what is left unsaid and goes unnoticed. RH